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Health Aff (Millwood). 2018 Nov;37(11):1779-1786. doi: 10.1377/hlthaff.2018.0717.

Scaling Safety: The South Carolina Surgical Safety Checklist Experience.

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William R. Berry ( ) is an associate director, senior adviser, chief implementation officer, and interim director of the Implementation Platform, all at Ariadne Labs, and a principal research scientist in the Department of Health Policy and Management, Harvard T. H. Chan School of Public Health, all in Boston, Massachusetts.
Lizabeth Edmondson is a senior program manager at Ariadne Labs.
Lorri R. Gibbons is vice president for development, South Carolina Hospital Research and Education Foundation, South Carolina Hospital Association, in Columbia.
Ashley Kay Childers is project lead, Safe Surgery South Carolina, South Carolina Hospital Association, and a senior lecturer in the College of Engineering, Computing, and Applied Sciences, Clemson University.
Alex B. Haynes is the director of the Safe Surgery Program at Ariadne Labs; an associate professor in the Department of Surgery, Massachusetts General Hospital; and a research associate at the Harvard T. H. Chan School of Public Health, all in Boston.
Richard Foster is executive director of the Alliance for a Healthier South Carolina, South Carolina Hospital Association.
Sara J. Singer is an adjunct professor of health care management and policy in the Department of Health Policy and Management, Harvard T. H. Chan School of Public Health; an affiliate member of Ariadne Labs; and a professor of primary care and population health in the School of Medicine and of organizational behavior in the Graduate School of Business at Stanford University, in California.
Atul A. Gawande is the founding executive director of Ariadne Labs; a general and endocrine surgeon at Brigham and Women's Hospital; and a professor in the Department of Health Policy and Management, Harvard T. H. Chan School of Public Health. He was also recently named CEO of a new health initiative founded by Amazon, Berkshire Hathaway, and JPMorgan Chase.


Proven patient safety solutions such as the World Health Organization's Surgical Safety Checklist are challenging to implement at scale. A voluntary initiative was launched in South Carolina hospitals in 2010 to encourage use of the checklist in all operating rooms. Hospitals that reported completing implementation of the checklist in their operating rooms by 2017 had significantly higher levels of CEO and physician participation and engaged more in higher-touch activities such as in-person meetings and teamwork skills trainings than comparison hospitals did. Based on our experience and the participation data collected, we suggest three considerations for hospital, hospital association, state, and national policy makers: Successful programs must be designed to engage all stakeholders (CEOs, physicians, nurses, surgical technologists, and others); offering a variety of program activities-both lower-touch and higher-touch-over the duration of the program allows more hospital and individual participation; and change takes time and resources.


Hospitals; Organization and Delivery of Care; Quality Of Care

[Indexed for MEDLINE]

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